Friday, August 26, 2011

The Morning Drill: August 26, 2011

Smile Brands Inc., the nation's leading provider of business support services to dental groups in the United States, is pleased to announce the grand opening of its next Bright Now! Dental office in Fresno, CA – the 67th office in the state of California. Bright Now! Dental will continue to grow in the state with offices slated to open in Murrieta, Upland, San Jose, Simi Valley, and Stockton later this year.

Smile Brands Inc. is the largest provider of support services to dental groups in the United States. Smile Brands Inc. provides comprehensive business support services so dentists can spend more time caring for their patients and less time on the administrative, marketing and financial aspects of the dental practice. Smile Brands Inc. services support more than 1,100 dentists and hygienists practicing in over 320 Bright Now! Dental, Monarch Dental, and Castle Dental offices in 18 states.

Based in Irvine, Calif., Smile Brands Inc. and its affiliated dental offices combined employ approximately 4,200 people nationwide.

One of the hallmarks of Steve Jobs' tenure as CEO of Apple Inc. was the secrecy that shrouded products he was about to unveil -- from the iPod to the iPhone to the iPad -- creating tremendous consumer interest.

Jobs' announcement Wednesday night that he was stepping down as the head of the hugely successful technology company he co-founded in a northern California garage 35 years ago was similarly thin on details, although speculation immediately turned to his ongoing health problems.

In a letter to Apple's board, the 56-year-old Jobs said he "always said if there ever came a day when I could no longer meet my duties and expectations as Apple's CEO, I would be the first to let you know. Unfortunately, that day has come."

This much is known about the health of Jobs, a legendarily private man: Since 2004, he has been fighting a rare form of pancreatic cancer called neuroendocrine cancer. In January, he took his second medical leave from Apple after undergoing a liver transplant for tumors that had spread to that organ.

Pancreatic cancer expert Dr. Craig Devoe, from the department of medicine at North Shore-LIJ Health System in New Hyde Park, N.Y., said that "neuroendocrine tumors are uncommon, with only a few thousand cases a year."

For those that affect the pancreas, the numbers are even lower with fewer than 1,000 cases a year in the United States. In contrast, there are around 40,000 cases of other pancreatic cancers a year, Devoe said.

Dr. David M. Levi, a professor of clinical surgery, liver and GI transplantation at the University of Miami Miller School of Medicine, said neuroendocrine cancer "is an unusual tumor. It can arise in a number of places, including the pancreas." Such tumors can also start in the lungs.

It's one of the few tumors that can benefit -- to some extent -- from a transplant, Levi said. Jobs' cancer started in the pancreas and then spread to the liver, making the liver transplant an option, Levi said, adding he has treated patients with this type of cancer and done liver transplants.

While the prognosis for neuroendocrine cancer is often better than for the more common type of pancreatic cancer, in which patients generally live less than a year after diagnosis, neuroendocrine cancer "can also be bad," Levi said.

Neuroendocrine cancer can return after treatment, Levi explained. And while a liver transplant can be effective, "it is not as great a picture as we first thought," he said. "A lot of these patients who have transplants eventually do recur."

"The vast majority of patients that have recurrent disease will die of their disease. One of the problems with the [liver] transplant is that now you are on immunosuppressant drugs, and while they keep you from rejection or destroying the liver, the immune system also would have helped deal with tumors," he said.

Common rules of thumb exaggerate how much weight people will lose from a given dietary calorie reduction, leading to unrealistic expectations and disappointment, researchers said.

Whereas patients are often told that cutting 500 calories a day will let them lose a pound a week, a more realistic formula is that such a caloric reduction would lead to a 50-pound loss over three or more years, according to Kevin D. Hall, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Md., and colleagues.

Even then, they explained in the Aug. 27 issue of The Lancet -- a special edition devoted to obesity -- such weight loss is possible only if the calorie reduction is actually maintained over that time.

The standard rules -- endorsed by the National Institutes of Health and the American Dietetic Association, among others -- fail to consider that human metabolism responds dynamically to changes in diet and body composition, Hall and colleagues asserted.

If a 300-pound dieter could really lose a pound a week by cutting his regular diet by 500 calories, he would vanish entirely in six years.

"This ubiquitous weight-loss rule (also known as the 3,500 [calorie]-per-pound rule) was derived by estimation of the energy content of weight lost, but it ignores dynamic physiological adaptations to altered body weight that lead to changes of both the resting metabolic rate as well as the energy cost of physical activity," the researchers wrote.

When people gain weight, their baseline energy needs increase, to keep the extra tissue alive and to move it around. Likewise, when weight is lost, their baseline needs decrease.

So when people cut calories below the baseline requirement -- thereby triggering weight loss -- the gap between their intake and their baseline energy needs begins to shrink. At some point, it may disappear altogether, at which point weight loss stops.

Hall and colleagues put together what they said was a better model of caloric intake and resultant weight loss, incorporating feedback mechanisms to reflect metabolic changes over time in response to diet and body weight.

It indicated that weight change in response to caloric restriction occurs over a relatively long period of time.

Each reduction of 100 kilojoules daily -- 24 calories -- in intake eventually leads to a loss of 1 kg (2.2 lbs) in body weight, the researchers determined. But only half that loss occurs in the first year. In three years, 95% of the ultimate loss will be realized.